| NPI | 1962791418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28ri03201500) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: NJ 25MG00160400) |
| 183500000X Pharmacist (Licence: CT pct.0011230) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2023-12-04 |